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Long-term Neurocognitive and Quality of Life Outcomes in Survivors of Pediatric Hematopoietic Cell Transplant
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  • Natalie Wu,
  • Kevin Krull,
  • Kara Cushing-Haugen,
  • Nicole Ullrich,
  • Nina Kadan-Lottick,
  • Stephanie Lee,
  • Eric Chow
Natalie Wu
Seattle Children's Hospital
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Kevin Krull
St Jude Children's Research Hospital
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Kara Cushing-Haugen
Fred Hutchinson Cancer Research Center
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Nicole Ullrich
Children's Hospital Boston
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Nina Kadan-Lottick
Yale University School of Medicine
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Stephanie Lee
Fred Hutchinson Cancer Research Center
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Eric Chow
Fred Hutchinson Cancer Research Center
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Abstract

Background: Pediatric patients who undergo hematopoietic cell transplant (HCT) are at risk for neurocognitive impairments; however, long-term studies are lacking. Procedure: Eligible survivors (HCT at age <21y and ≥1y post-HCT) completed a 60-question survey of neurocognitive function and quality of life, which included the Childhood Cancer Survivor Study Neurocognitive Questionnaire (CCSS-NCQ) and the Neuro-Quality of Life Cognitive Function Short Form (Neuro-QoL). Baseline demographic and transplant characteristics were retrieved from the institutional research database. Analyses of risk factors included univariate comparisons and multivariable logistic regression. Results: Participants (n=199, 50.3% female, 53.3% acute leukemia, 87.9% allogeneic transplants) were surveyed at median age of 37.8 years (range 18-61) at survey and median 27.6 years (range 1-46) from transplant. On the CCSS-NCQ, 18.9-32.5% of survivors reported impairments (Z-score >1.28) in task efficiency, memory, emotional regulation, or organization, compared with expected 10% in the general population (all p<0.01). Certain co-morbidities were associated with impaired CCSS-NCQ scores. However, survivors reported average Neuro-QoL (T-score 49.6±0.7) compared with population normative value of 50 (p=0.52). In multivariable regression, impaired Neuro-QoL (T-score <40) was independently associated with hearing issues (OR 4.79, 95% CI 1.91-12.0), history of stroke or seizure (OR 5.22, 95% CI 1.73-15.7), and sleep disturbances (OR 6.90, 95% CI 2.53-18.9). Conclusions: Although long-term survivors of pediatric HCT reported higher rates of impairment in specific neurocognitive domains, cognitive quality of life was perceived as similar to the general population. Subsets of survivors with certain co-morbidities had substantially worse neurocognitive outcomes.

Peer review status:UNDER REVIEW

24 Aug 2020Submitted to Pediatric Blood & Cancer
24 Aug 2020Assigned to Editor
24 Aug 2020Submission Checks Completed
08 Sep 2020Reviewer(s) Assigned
25 Sep 2020Review(s) Completed, Editorial Evaluation Pending